Machine or man?

Pain meds are not regular, just when I feel some back pain which has only been happening last few months, it isn't major and some days have nothing. Small codeine and ibuprofen. No pain tossing and turning but can be restless sleeper with sheets pulled.

I will often have 2-3 wakes recently, usually at least 1. Some nights I sleep 6 hours, some 7. Last night I had chronic insomnia and slept 90 minutes. SOmetimes happens after a partially successful cpap night, or a very bad night when energy comes in waves. One thing I noticed when CPAP worked is that I woke feeling rested and was tired at bedtime almost without fault, so normal sleep does help that too.

Does resmed detect when patient is sleeping? F&P keeps pressure low until it knows patient has fallen asleep then increases it if needed, has a sensawake feature which lowers it again if patient wakes.

No, ResMed machines don't know if you are asleep or not.
And to be honest...I don't know how F & P says they do. No one else can do it. It has to be from breathing and breathing doesn't guarantee awake or asleep. If it were that easy everyone would do it.

Ok had some more nights with no real benefit. Looking at the graph from last night it never seems to go above 11. I will sometimes wake up and the mask seems to be making more noise and I'm not sure why as pushing it against face makes no difference (would do if a leak) so some mornings if I have an hour or so left until wake time I take off the mask to finish sleep in peace.

Think I will try one more night like this then maybe switch to CPAP mode.

Oh Pugsy, I tried to get your ASV machine but failed as I only have OSA diagnosis.

Sensawake may detect breathing patterns typical to wakefulness and respond to that.
I would disable the feature, as I don't really trust the hype.

Well here is latest. Been having some bad nights with the mask recently, but last night was particularly annoying. I woke up many times and always to a big WHOOOSH coming from the mask. I never understand why the mask is making the noise and reset the machine by taking the mask off then putting it back on again. Last night I tried covering the upper vents on the mask a few times and I could hear the big CLUNK of the mask valve hitting into place then the noise went back to normal.

Could the mask be faulty and the machine is causing the escape valve to open? That two way valve is only meant to open to allow you to breathe when machine is off I think. Here is last night's chart. The morning feeling is groggy and tired.

Looks to me like you're shutting the machine off every time the pressure goes up. Is that because the mask starts leaking?
One thing I see is that all your apneas are centrals?

I suppose that if the anti-asphyxia valve is getting stuck open it could cause the problem you describe but as long as the silicone flapper isn't warped or damaged it should work very reliably. Have you closely inspected the valve flapper?

The shut machine off times were when it woke me up with the loud air noise and I disconnected and reconnected usually only a few minutes max between mask on and off.

The valve looks ok visually.

It's most likely mask leaks. How old is the cushion, headgear, etc.?

Overflow wrote:I am also using EPR on the S9 now but truthfully I never had any exhalation sensitivity, I think I am more sensitive to sudden gusts of air which I suspect the S9 might be laying on me. I certainly had fewer wakes on the F&P, but not sure that likes me much anymore! (emphasis added)

There are three main possible sources for "sudden gusts of air" depending on when you are feeling them and how pronounced they are:

1) The AUTO algorithm increasing your pressure because of clusters of OAs and Hs, FLs, and snoring. It's hard to tell, but I suspect that even as minor as the FL are, they're the major reason that the S9 is deciding to increase the pressure from 7cm to 10+ cm several times during the night. Notably each of the wakes that are clearly visible in the data occur shortly after the S9 has increased the pressure to compensate for something. (And the "something" is NOT clusters of obstructive events.)

2) The EPR algorithm. At the beginning of each exhalation the pressure is dropped by 1-3 cm depending on what you have the EPR set at. You have your EPR = 1. So the pressure drops by 1 cm at the beginning of each exhalation. The pressure is then increased by 1 cm at (roughly) the start of each and every inhalation, but the pressure actually starts this increase towards the tail end of the exhalation. If you are really sensitive, the timing of the start of the pressure increase can feel like the machine is trying to rush you to inhale by blowing additional air down your gut.

3) Unintentional leaks. As long as the leak is not too large, the machine will compensate for an unintentional leak by blowing more air into the leaky semi-closed pressurized system. While none of your leaks are very bad, if you are very sensitive to the airflow, it could be the minor leaks you do have---particularly at the end of the night----may be responsible for the "sudden gusts of air" feeling that is so disturbing.

But given the timing of the wakes, I suspect that you're mainly reacting to #1---pressure changes from the AUTO algorithm. So first I'd suggest switching from AUTO mode to straight CPAP mode. Next, if you are feeling like the machine is rushing the inhalations, then turn EPR OFF so there's no reduction in pressure at the start of each exhalation followed by an increase in pressure at the beginning of each inhalation.

So what next? I am a very sensitive sleeper when I am in my OSA/fatigue mode. The slightest aberration can cause me to wake, so for now I am back to wearing earphones or earplugs at night so thatisn't that reason. Is the S9 waking me up? I am not sure. The masks are not ideal and I really want it to work as the other machine seemed to stop being effective. I might have to relent soon and go back to F&P Icon auto soon but my real question is, should I be looking into something like Bipap which from my very brief reading seems to sometimes suit those which are more sensitive?

Given that pressure changes seem to bother you, I'd suggest not getting a BiPAP just yet. In bi-level therapy the pressure is constantly changing from IPAP to EPAP and back with each and every breath. For many people this change of pressure feels more normal, but it's got to be completely in sync with your own breathing and since you don't report any problems with exhaling against pressure, it's possible that adding even more pressure changes will make things feel worse instead of better.

Bama Rambler wrote:It's most likely mask leaks. How old is the cushion, headgear, etc.?

Just over 2 weeks. Also cut the chin bit off few days ago which seems to help fit a bit (I thought anyway!)

robysue wrote:

Overflow wrote:I am also using EPR on the S9 now but truthfully I never had any exhalation sensitivity, I think I am more sensitive to sudden gusts of air which I suspect the S9 might be laying on me. I certainly had fewer wakes on the F&P, but not sure that likes me much anymore! (emphasis added)

There are three main possible sources for "sudden gusts of air" depending on when you are feeling them and how pronounced they are:

1) The AUTO algorithm increasing your pressure because of clusters of OAs and Hs, FLs, and snoring. It's hard to tell, but I suspect that even as minor as the FL are, they're the major reason that the S9 is deciding to increase the pressure from 7cm to 10+ cm several times during the night. Notably each of the wakes that are clearly visible in the data occur shortly after the S9 has increased the pressure to compensate for something. (And the "something" is NOT clusters of obstructive events.)

2) The EPR algorithm. At the beginning of each exhalation the pressure is dropped by 1-3 cm depending on what you have the EPR set at. You have your EPR = 1. So the pressure drops by 1 cm at the beginning of each exhalation. The pressure is then increased by 1 cm at (roughly) the start of each and every inhalation, but the pressure actually starts this increase towards the tail end of the exhalation. If you are really sensitive, the timing of the start of the pressure increase can feel like the machine is trying to rush you to inhale by blowing additional air down your gut.

3) Unintentional leaks. As long as the leak is not too large, the machine will compensate for an unintentional leak by blowing more air into the leaky semi-closed pressurized system. While none of your leaks are very bad, if you are very sensitive to the airflow, it could be the minor leaks you do have---particularly at the end of the night----may be responsible for the "sudden gusts of air" feeling that is so disturbing.

But given the timing of the wakes, I suspect that you're mainly reacting to #1---pressure changes from the AUTO algorithm. So first I'd suggest switching from AUTO mode to straight CPAP mode. Next, if you are feeling like the machine is rushing the inhalations, then turn EPR OFF so there's no reduction in pressure at the start of each exhalation followed by an increase in pressure at the beginning of each inhalation.

So what next? I am a very sensitive sleeper when I am in my OSA/fatigue mode. The slightest aberration can cause me to wake, so for now I am back to wearing earphones or earplugs at night so thatisn't that reason. Is the S9 waking me up? I am not sure. The masks are not ideal and I really want it to work as the other machine seemed to stop being effective. I might have to relent soon and go back to F&P Icon auto soon but my real question is, should I be looking into something like Bipap which from my very brief reading seems to sometimes suit those which are more sensitive?

Given that pressure changes seem to bother you, I'd suggest not getting a BiPAP just yet. In bi-level therapy the pressure is constantly changing from IPAP to EPAP and back with each and every breath. For many people this change of pressure feels more normal, but it's got to be completely in sync with your own breathing and since you don't report any problems with exhaling against pressure, it's possible that adding even more pressure changes will make things feel worse instead of better.

Thank-you for that detailed analysis robysue. That is an idea about going back to CPAP mode, although it was an auto cpap that worked for me where fixed pressure never did before. But never tried it with this mask. What sort of pressure would I go for, 10?

Will try same again tonight but make sure mask is well fitted. Also I've been putting moisturiser on last few nights so that could have been making skin too slick. Certainly helped to make a greenhouse effect in mask!

Overflow wrote: Thank-you for that detailed analysis robysue. That is an idea about going back to CPAP mode, although it was an auto cpap that worked for me where fixed pressure never did before. But never tried it with this mask. What sort of pressure would I go for, 10?

Your 95% pressure is 9.6ish.

If you are willing to risk a few more events, you could start with CPAP = 9 in my opinion. Or CPAP = 9.5. I don't see a need to start at CPAP = 10.

Will try same again tonight but make sure mask is well fitted. Also I've been putting moisturiser on last few nights so that could have been making skin too slick. Certainly helped to make a greenhouse effect in mask!

Which brand of moisturizer? It could be that switching to a different skin care product might help. Or make sure you do the moisturizing well before bedtime.

robysue wrote: Which brand of moisturizer? It could be that switching to a different skin care product might help. Or make sure you do the moisturizing well before bedtime.

Cetaphil. It is way too greasy and remains on skin surface for ages. Really need something that soaks in probably.

Ok last night was an interesting night as my alarm clock went two hours behind (radio set) so I woke up at nearly 9am instead of 7 like I should be for good hygiene.

I was woken as you can see on the graph by machine going to 11.X and it was staying there so I removed mask and set machine from auto to cpap at 9. I still had a few more wakes due to noise though, so tonight I am trying an identical mask to see if my other one is somehow faulty (got two of them).

My AHI seems to be higher on 9, what do you think? I am unsure but after a few hours and my first wake I could sense maybe a slight headache but may have been imagining it. I am tempted to try a narrower auto tonight like starting at 7.8 to 11 to see how that fares.





tonight will definitely be shorter as I will be sleeping late and waking early to make up for waking late today.

Ok just thought I'd post first complete night of data from ASV machine I'm trying out. Clearly I've ramped way too many times but on each wake I'd be worried about being blown up awake all night like on first two nights. This was first whole night I'd had since getting machine and needed 3 sleeping tablets to get off at 23:45 despite only getting 30 minutes of sleep the night before. I'm using SH on a machine with more even scaling so it is easier to read now! Subjective feel was ok on wake, and then sleepy for about 4 hours which was probably residuals from sleeping meds.




Main event through the night seemed to be pressure pulses at 107 events. 3 Flow limitations, 1 clear airway and 1 hypopnea.

Would machine still be able to record any AHI detail while ramping? Or could I be losing sleep efficiency during the 2.5 hour period I was ramping last night. I was using wisp mask with mouth taped shut.

I can't add much being a newbie except that my S9 is almost silent. I'm not sure if you are hearing machine noise or just worried about ambient noises waking you up but maybe a "sound machine" instead of earplugs would be worth a shot.

I've been sleeping with a sound machine set to white noise for years to knock out ambient noises waking me up.